ACA Premiums to Spike 18% in 2026 Amid Policy Shifts and Rising Costs
The upcoming open enrollment season for health insurance is expected to reveal significant premium increases across commercial and Medicare markets, with the Affordable Care Act (ACA) marketplaces facing the steepest hikes. Data from the Kaiser Family Foundation shows ACA insurers are requesting a median 18% premium increase for 2026, the largest since 2018 and substantially higher than last year's 7% hike. Certain states report even higher proposed increases, especially impacting unsubsidized individual market consumers.
Rising healthcare costs contribute notably to these premium surges. Medical service prices and usage rates are driving annual healthcare cost growth estimated at 8% for 2026, outpacing general inflation rates and underscoring systemic cost pressures. Legislative changes, including the recent "Big Beautiful Bill" signed into law, could exacerbate coverage losses; the Congressional Budget Office projects nearly 12 million Americans may lose health insurance by 2034, primarily due to Medicaid disenrollment.
This legislation formalizes earlier administration rules allowing ACA subsidies to expire, tightening verification processes, shortening enrollment periods, and imposing fees on automatically reenrolled consumers with zero-premium plans. These changes are expected to decrease enrollment and increase state-level costs related to Medicaid and uncompensated care for newly uninsured individuals.
Legal challenges are underway, with a federal court granting a preliminary injunction against implementing these subsidy reductions and regulatory changes, temporarily preserving ACA protections including limits on out-of-pocket expenses. However, the law's codification of these rules may influence ongoing judicial proceedings and the future of these protections.
Long-term trends highlight escalating health insurance costs; family premiums have risen nearly 300% since 2000, and out-of-pocket deductibles, especially high-deductible health plans, have surged sharply. Standard ACA silver plan deductibles have doubled over the past decade, nearing $5,000. Expiration of enhanced ACA tax credits, initially expanded during the COVID-19 pandemic to support affordability up to incomes around $60,000, threatens to significantly increase premiums by up to 90% in rural areas and 75% overall, impacting affordability for subsidized enrollees.
Insurer projections suggest healthier individuals may exit the market, leading to a risk pool dominated by higher-cost members and driving further premium increases and cost-sharing burdens. The uncertainty around congressional action to extend subsidies adds to market volatility and potential coverage instability heading into 2026.